In an interview with CNN’s Jake Tapper on Monday May 1, 2017, Congressman Mo Brooks (R-Alabama) reaffirmed his support for the proposed 2017 Republican healthcare bill that would deny coverage for individuals with pre-existing conditions. While explaining his controversial position, Brooks asserted that the plan would help “offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people—who’ve done things the right way—that are seeing their costs skyrocketing” (Rozsa 2017).1 In the interview, Brooks articulated one of the theoretical underpinnings of the Republican healthcare platform—the existence of a causal relationship between a persons’ behavior and their overall physical health. Specifically, Brooks highlighted the belief that “good people” who live “the right way” are healthier and more deserving than sick people who, the argument implies, live “the wrong way.” Brooks’ use of the phrase “good lives,” moreover, unintentionally echoes the colonial Puritan term “good Livers”—people whose health and prosperity set them apart from “bad people” or “bad Livers.”2 While Brooks almost immediately attempted to qualify his comments by noting that some people “with pre-existing conditions … have those conditions through no fault of their own,” and therefore are also decent people who deserve help to pay for medical costs, he did not fundamentally revise his argument that good livers are healthier and worthier than bad livers (Rozsa 2017). As a result, Brooks’ remarks during the CNN interview were widely considered offensive and prompted significant backlash. Further, though the Senator did not explicitly invoke religious rhetoric, Brooks’ conflation of lifestyle habits with judgments of a person’s worth taps into a long history of reading patient health as a moral index that dates back to the colonial period—an index that is still embraced by some to this day. As Brooks’ interview shows, in our public and private discourse we continue to search for teleological explanations for illness; however, such explanations need not blame patients for their conditions. Rather, as early American medical narratives reveal, connecting individuals’ behavior to their overall health outcomes can be empowering when it actively involves people in their own medical care.

In order to provide context for some of the current debates about health and recovery, this essay offers a literary history of the restitution narrative—stories primarily about the restoration of health—in early eighteenth-century New England. One notable feature of this genre arises from the fact that, prior to the Enlightenment, theology and medicine overlapped in ways that are less common, or more controversial, today. For instance, it was common for ministers to double as physicians for their communities, becoming in practice minister-physicians; this was, in large part, because ministers had elite educations that included training in not only theology but also contemporary math and natural philosophy.3 Because colonial Puritans—the reformed Protestants who settled the Massachusetts Bay Colony in the seventeenth and eighteenth centuries—saw religion and medical practice as compatible epistemologies, their interpretation of restitution narratives offers a construction of illness that does not preclude the possibility of recovery and subsequent inclusion in the community. In fact, recovered individuals were central to gauging the overall health of Puritan society because they revealed God’s favor and protected the community from further outbreaks of disease.

This essay argues that Puritan medical texts reveal an alternate way of considering patients and enabling patient agency. Instead of blaming people for their own illnesses, in these accounts, patients have considerable agency because they must be actively involved in reforming the sinful behaviors that caused their conditions. It is only through their own volition that patients can recover; in other words, afflicted individuals must do more than simply take medicine. In addition to consulting the best medical practitioners available and following their prescriptions for treatment, patients must also rectify their underlying sinful behavior. In the Puritan medical epistemology, treatment will ultimately be ineffective if patients choose not to repent and reform. Thus, they are the primary actors in their own convalescence. Further, recuperated individuals have the imperative to engage in a form of preventative medicine through narrative by sharing their stories with their community so that others may avoid specific sins—and therefore specific illnesses—in the future. In this way, these texts anticipate the work of modern public health humanities, which recognizes how stories can shape public policy and lead to “‘organized community action’” (Saffran 2014, 106).4 For colonial Puritans, recovered individuals were vital to the communal good because they had the capacity to indicate God’s pleasure (or displeasure) with his chosen people in New England and provided an opportunity for the edification of all members of society. Stories of illness and recovery continue to wield considerable cultural significance; as Lise Saffran argues, “We may, in fact, be hard-wired to need anecdotes in order to absorb even the most statistically solid evidence” (106). Through restitution narratives, Puritans were authorized to share their experiences of sin, repentance, and recovery; in other words, these texts serve as “representative stories that accurately and persuasively individualize common experience” and encourage readers to take preventative steps by reforming sinful behaviors to prevent future outbreaks of illness in their communities (Steiner 2005, 2903).

In order to achieve the goal of defending the community from sin and illness, the generic conventions of Puritan conversion narratives—testaments of faith that recorded an individuals’ recovery from sin—were adapted in medical restitution narratives. This article analyzes the particular example of Cotton Mather (1663-1728), one of the most renowned ministers and natural philosophers in colonial Massachusetts and author of The Angel of Bethesda (1724, pub. 1972), the first medical treatise composed in North America. Ultimately, Mather’s text reveals how Puritan medical restitution narratives validate patient involvement in their own medical care, as well as how a theological framework enables patients to construct illness and restitution as culturally- and spiritually-significant experiences.

Restitution narratives

Puritan interest in the spiritual causes of illness aligns with what scholars have termed “Medical Providentialism”: “the belief that God intervened in human affairs through matters of illness and healing, especially among his chosen few in New England” (Priewe 2012, 77). In other words, Puritan colonists often read illness and epidemics through a biblical lens, interpreting outbreaks of disease as signs from God that those afflicted need to recognize their sins and repent.5 Medical providentialism is one reflection of “theological pathogenesis,” the belief that “sin is the most important, albeit not the only cause of illness” (Priewe 2014, 295). If theological pathogenesis is the belief that God causes illness, then medical providentialism provides God’s motive for so doing: He sends disease in order to compel his people to return to him. Only through repentance can the underlying sinful condition of the individual/community be cured.

Medical providentialism and theological pathogenesis fit within the larger Puritan belief system as they encourage individuals to track affliction-grace cycles with outbreaks of personal or communal illness serving as discursive messages indicating the Puritans’ status in the eyes of God. Thus, Puritan accounts of medical restitution draw heavily on the conventions of the conversion narrative. Though the exact origins of the form are unclear, Patricia Caldwell notes that, by the mid-seventeenth century, “three major standards” of the conversion narrative had appeared: “(1) relation before the entire congregation of (2) a genuine experience of conversion (not doctrinal ‘knowledge’ or ‘belief’), which (3) was required of all who would join the church” (Caldwell 1983, 46). While the conversion experience was deeply personal, in order to participate in communion—and, for men in New England, to appreciate full legal rights in the colony prior to 1647—converts had to share their faith in front of the church leadership, and, ultimately, “it had to be delivered before and voted upon by the entire membership” (Caldwell 1983, 46). While the conversion narrative schema required converts to conform to the genre conventions authorized by the supervising ministers, they also empowered individuals to interpret events in their own lives and to share their analysis with their ministers and the congregation. Thus, afflicted individuals recounted the significance of illness in their lives, and the form of the conversion narrative enabled them to articulate publicly what they had learned and how they recovered both spiritually and physically.

Furthermore, the overlap between conversion narratives and medical restitution narratives illuminates how, unlike much modern discourse that situates religion and science in an antagonistic binary, in the seventeenth and early eighteenth centuries the two were viewed as compatible knowledge systems. In part, the Puritans’ blend of medicine and theology is informed by biblical typology and the notion of God and/or Christ as the healer of the soul. A common example comes from the Gospel of Luke; when the Pharisees question Christ for associating with “publicans and sinners,” he responds, “They that are whole need not a physician; but they that are sick. I came not to call the righteous, but sinners to repentance” (Luke 5:31-2). As Tim Cooper notes in his analysis of the prominent Puritan minister Richard Baxter (1615-1691), “A believer must first see Christ as his or her Physician, and having perceived the extent of the appalling disease must humbly submit to Christ’s ministrations on the vitiated soul” (2007, 15). In part because of this understanding of God as vital to spiritual and, I contend, physical healing, the image of God the physician is routinely invoked by Cotton Mather and many other Puritan ministers and church members. One of Baxter’s most famous sermons, delivered in 1652 but published in 1795, exemplifies this notion, contending that ministers “are set over you to advise you, for the saving of your soul, as physicians advise you for the curing of your bodies,” a point that would have registered with readers in large part because ministers so often literally functioned as physicians in the seventeenth century (Baxter 1795). Thus, Puritan minister-physicians adopted epistemological methods that showed appreciation for both physical and spiritual health and that understood the two as concordant. Therefore, researching and contributing to Enlightenment medical discourse was a seamless part of their clerical responsibilities—as a result, their work is highly attuned to the linked spiritual and physical health of their congregation.

Further, many Puritan minister-physicians recognize that patients may feel helpless during an illness and thus take pains to emphasize the role of repentance and reformation in the healing process, thereby empowering patients and giving them agency in the sick room. Patients may not have the medical knowledge needed to treat illness themselves, but they do have the authority to address their spiritual health by repenting for past sins and reforming their behavior in the future, and, in so doing, to speed their own healing. In this way, colonial Puritan medical advice is part of what Sarah Rivett terms the “science of the soul,” the process “for discerning, authenticating, collecting, and recording invisible knowledge of God as it became manifest in the human soul” (2011, 5). New England Puritans adopted the empirical methods of the New Science—“broadly defined as a practice based on the inductive accumulation of observations and personal experiences”—and applied them to the study not just of their souls but also to their corporeal health (7).6 From this perspective, we ought not approach theological pathogenesis and medical providentialism simply as outmoded epistemologies that rely on a pre-modern world view. While certainly incompatible with modern medical standards, these epistemologies are, in fact, significant because they enabled patients to address illness from a position of action and control, rather than one of passivity or helpless reception of care. Instead, patients are observers and interpreters of the spiritual import of their somatic symptoms. The metaphor of Christ the physician is useful again for providing a framework for understanding this concept of patient agency and its functioning; Cooper, for instance, draws on the metaphor to argue that Puritan converts had spiritual agency, stating that: “The patient, then, is not without some responsibility in the vitalizing process… The patient must undertake to obey the prescription, and to perform all life-enhancing Christian duties” (2007, 15). Though here he is referring to spiritual reformation, spiritual and physical health are, as we have seen, considered to be linked, and, as such, it is not a great stretch to apply this same notion of agency to patients taking treatments or repenting for their sins at the direction of ministers and/or physicians. Because sin was considered to be central to medical experiences, Puritan patients, as the only ones capable of repenting for their sins, were engaged in the healing process, playing a role that was just as important, if not more important, than that of the physician; while the physician could cure the body, only the patient, through the grace of God, could heal the soul.7

Finally, the Puritan emphasis on the spiritual aspects of illness not only creates a space for patient agency, it also frames their understanding of medical restitution—returning the body to a healthy state—and of the purpose of restitution narratives. The field of narrative medicine offers tools for critically examining patient narratives and, thus, new possibilities for reading early American texts. As Rita Charon explains, narrative medicine is “medicine practiced with [the] narrative skills of recognizing, absorbing, and being moved by the stories of illness” and therefore enables practitioners to use close reading techniques to analyze how patients describe their conditions (2006, 4). One of the three dominant narrative types identified by scholars of narrative medicine is the restitution narrative, which Sara Wasson defines as texts that tell “the story of getting better (through the heroic agency of medical practitioners)” (2015, 5).8 Significantly, major scholars of narrative medicine contend that patient narratives are fundamentally postmodern and that, “This sense of need for a personal voice depends on the availability of the means—the rhetorical tools and cultural legitimacy—for expressing this voice. Postmodern times are when the capacity for telling one’s own story is reclaimed” (Frank 2013, 7).9

Though Arthur W. Frank acknowledges that “the restitution plot is ancient,” citing Job as an example in his analysis of the genre, he—like most scholars of narrative medicine—provides very few additional pre-modern examples, instead relying primarily on modern and postmodern texts, arguing that “the assumption of restitution” is “returning the sick person to the status quo ante” (2013, 80, 83). Further, he concludes that modern “medicine’s hope of restitution crowds out any other stories” (83). In other words, those facing chronic or terminal illness are precluded from restitution narratives and must rely on one of the other narrative types Frank identifies.10 Yet there is a deeper literary history of this genre prior to the twentieth century that reveals differences in attitudes about, and constructions of, restitution both culturally and temporally; by analyzing seventeenth- and eighteenth-century examples of restitution stories, this paper supplements Frank’s growing taxonomy of medical narratives. Cotton Mather, for instance, not only writes his own restitution narrative in The Angel of Bethesda, he also includes an entire chapter exploring what it means to be fully healed titled, “Restitutus.” Restitution narratives, as described and employed by Puritans such as Mather, do not necessarily privilege the “heroic agency of practitioners” (Wasson 2015, 5), nor do they depict patient agency as “limited to taking one’s medicine and getting well, wellness being defined in contrast to illness” (Frank 2013, 91). Though Puritan narratives also largely seek an end point resulting in physical wellness, they validate patient agency by giving individuals the space to recount how they have reformed their sinful behaviors. The genre likewise requires them to share their experience with others in order to reveal God’s glory and to serve as an example for the edification and protection of others. By recognizing how theologically-based restitution narratives testify to the spiritual and physical recovery of patients, we can better understand how and why people have been writing these narratives for centuries, thereby bridging the gap between Job and the post-modern era. In fact, elements of restitution narratives appear in many Puritan genres. In conversion narratives, testaments of faith, poetry, letters, sermons, and diaries, patients anticipate the work of public health humanities as they seek to transform illness into a social discourse that holds the potential to reconnect them with their community by displaying their somatic health and to offer warnings to others on how to avoid, or treat, illness. Reading eighteenth-century medical narratives in this way reveals alternate constructions of sickness and health, illuminating patient experiences in early America.

Diverging models: patients in European medical discourse

Though British medical texts at the turn of the eighteenth century tended to be less focused on religion compared to those coming from New England, it is important to note that European scholars and practitioners, including members of the Royal Society of London, did not see themselves as at odds with Christianity; on the contrary, the founders of the Society believed that theology and the New Science were compatible epistemologies.11 Indeed, many leading medical practitioners, including Robert Boyle (1627-1691) and royal physician Gideon Harvey (1669-1754), invoked God and religion as a basis for justifying their work.12 Harvey’s pharmacopeia, The Family Physician, and the House Apothecary (1676), for instance, opens by situating medical practice within a religious framework. In the first sentence of the introduction, he acknowledges that “Diseases and Death are marks of the Divine Justice in the punishment of Sin, So the Art of Physick must be acknowledged a derivative from the transcendent Mercy of the Great God” (Harvey 1676). Fundamentally, Harvey’s text is a secular tool created to help poor families make their own simple medicines for common ailments, and to avoid paying usurious apothecaries’ fees. Yet Harvey opens by invoking the role of God in both causing and curing disease—that is, the work begins with an expression of medical providentialism. The religious rhetoric, however, largely disappears in the main body of the text; medical providentialism is not, in this case, used to justify Harvey’s medical recipes but rather to justify his circumvention of apothecaries.

By the late seventeenth century, most physicians in Europe were placing less emphasis on God in their medical writings and were instead beginning to highlight methods of the new empiricism as they tested treatments before circulating written results to the witnessing public.13 For instance, in the preface of his Medicinal Experiments; or, a Collection of Choice Remedies, For the Most part Simple, and Easily Prepared, Robert Boyle writes that the remedies had been distributed for field testing and that many of the reported results had “sometimes strangely outdone Expectation” (Boyle 1692). In other words, medicines were not simply collected and distributed—rather, Boyle’s pharmacopeia required a team of physicians to test each remedy on actual patients. God is not mentioned, nor does Boyle attempt to determine the cause of illnesses. In this way, Boyle’s work is representative of the dominant trends in European medical discourse at the time, dialogue that was increasingly secular and that depicted patients as passive recipients of care.

While Puritan minister-physicians foregrounded medical providentialism and patients’ agency in their own recovery, publications by their European counterparts often were focused on patients as corroborating evidence for proto-clinical trials or as conveyors of status and authority. For instance, in “An Invitation to the Use of Simple Medicines,” Boyle writes “I know a very great person to whom Honey, whether inwardly taken, or outwardly apply’d, is almost as hurtful as Poyson” (1685, 145). Boyle’s description of what is most likely a case of honey allergy seems less important in this anecdote than his efforts to highlight the significance of the patient as an important individual. The only thing readers learn about the person, besides his or her negative reaction to honey, is that he or she is “very great” (145). The invocation of greatness functions as a tool to confirm and validate the knowledge Boyle imparts.

Often in Boyle’s “An Invitation,” anecdotes about patients seem, in reality, to be more about the doctor or natural philosopher. In one lengthy case study, Boyle describes the plight of a rich, “scrophulous (sic) patient” who was being treated by a “famous Chyrurgion (sic)” (155). Achieving little success at treating the large tumor in the patient’s throat, the surgeon remembered a treatment of “Paronychia, or Whitlow grass” recommended by Boyle, “Whereby the Tumor was at length resolv’d, and the Patient secur’d, so much to the Physicians Reputation as well as Profit” (155, 156). The patient’s cure, then, augments the reputation and fortune of the surgeon, while the patient as a person is almost completely irrelevant. Indeed, the little information we receive about this individual is that he is rich, a detail that again suggests his value to the physician. In these texts, patients seem to exist largely to serve as bodies on which physicians can test medical treatments and/or as a living testimony to the greatness of the treating doctor or surgeon. Using a treatment on an elite person seems to convey the quality of the cure in a way that providing the same care to a poor person does not.14 In many ways, this is logical because these texts work in multiple registers. First, testimony affirming the quality of the cures enables practitioners such as Boyle and Harvey to sell more books. In turn, practitioners using these cures will be more widely sought out if they can advertise their effectiveness. Patient narratives, in this context, work to affirm the value of consulting professional doctors at a moment when many people could not afford the fees charged by doctors and surgeons. As such, Boyle’s text is simultaneously a method for testing and disseminating high-quality medical knowledge and a promotional tool for himself and for the practitioners relying on his recommendations as they treat patients.

As the medical field became increasingly secular and professionalized throughout the eighteenth and nineteenth centuries, the role of patients in American medical practice came to follow the European model, leading to Frank’s observations at the end of the twentieth century that, in restitution narratives, the practitioner is the protagonist, while the patient is merely “the object of that protagonists’ heroism” (2013, xiv). In contrast, colonial Puritans coping with illness were often vital participants—if not the outright heroes—of their own restitution narratives. Especially considering the dissatisfaction some patients feel at being subordinated in their own medical narratives, it is worth examining alternate ways of considering patient agency in restitution stories before the rise of modern medicine.

Validating patient agency in medical encounters

Cotton Mather’s medical writing serves as an interesting case study for considering the different ways that seventeenth- and eighteenth-century medical scholars and practitioners engaged with patients in their publications because his work diverges from European norms in several ways. First, unlike texts by scholars such as Harvey and Boyle, which are clearly intended for either patients—as in pharmacopeias or practitioners as in Boyle’s treatises—Mather’s Angel of Bethesda incorporates elements of multiple medical genres. The book is problematically “addressed simultaneously to physicians and to the public at large,” to both the “busy housewife” and “the educated readers willing to consider scientific and philosophical questions” (Beall and Shryock 1954, 60; Levy 1979, 113). The modern published edition comprises more than three hundred pages and includes more than fifty pages of endnotes translating sections composed in Latin and Greek, as well as identifying and contextualizing the more than two hundred fifty classical, scientific, and theological texts Mather cites.15 In the first eight chapters, Mather articulates the medical and theological philosophies that inform the text. The majority of the other fifty-eight chapters follow a pattern: they begin by identifying the condition that is the subject of the chapter, articulate the sins that cause the condition and the best prayers or biblical readings for patients to use to repent for that particular sin, and they then provide an exhaustive list of every cure Mather has ever encountered for the condition. There are usually dozens of cures and recipes included, ranging from those recommended by Pliny the Elder (23-79 AD) to suggestions Mather received from the housewife who lives down the street. Rather than endorsing one particular cure, Mather creates a compendium of possibilities for readers to try based on their preference and/or on what ingredients they have available. Unfortunately, instead of becoming a useful resource to multiple audiences, the text did not effectively meet the needs of any audience. Priewe sums up the critical consensus: though Mather intended for his book to be useful to a wide variety of people, “the diction, intellectual scope, and employment of Latin and Greek passages would have made The Angel of Bethesda in part inaccessible to the majority of common readers in New England” (2014, 316). Most scholars agree that the “incoherent intended readership” was a major factor for why the book was not published in Mather’s lifetime (317).16

Nonetheless, Mather’s recognition that patients, not just practitioners, would be reading his text is a valuable aspect of his medical writing, one that was not appreciated by prospective readers and publishers in 1724. Due to the limited number of practitioners and to the high costs of medical treatment, many people relied on folk cures or home recipes in place of—or in conjunction with—prescribed treatments from minister-physicians. English herbalism was widely practiced in the colonies, and domestic manuals and pharmacopeias provided multiple options for medical care. Because many of the professional boundaries we associate with medical practitioners were not established until the nineteenth century, afflicted individuals had a wide network of folk practitioners, midwives, physicians, and surgeons available. In other words, people were able to choose whom to consult about their care. Indeed, Mather cautions readers against seeking too many opinions, instead encouraging them to trust in God above all mortal physicians.17 Despite his call to trust in God, Mather himself nevertheless offers a plethora of treatment options throughout The Angel of Bethesda. It is notable that the construction of the text foregrounds the afflicted person, with each chapter beginning by telling readers how to address their sinful behaviors before providing recipes for medications. The implication, then, is that the medicines will be useless unless combined with reformation and repentance. In other words, the patients must act first. Thus, by writing to dual audiences, Mather validates patients as a vital part of the healing process, ensuring that they have access to the same information as their practitioners. He also clearly identifies methods for them to be involved in effecting their own cures. For instance, he encourages readers immobilized by rheumatism to spiritual action, imploring them to “lett thy present Condition, wherein thou hast the Use of thy Limbs taken from thee, Stirr thee up very particularly, to Lament thy former Inactivity in the Service of God; […] And Resolve, with the Help of God, that if He Restore thee, thou wilt be more Active in Doing of Good” (80). In Mather’s text, rather than being merely a body passively receiving treatment, the patient becomes a participant in the healing process, one who must act even when physically incapacitated by illness. Though the ill may feel their power is limited, they are nevertheless the only ones who can cause spiritual—and therefore permanent physical—healing by reforming their sinful behaviors. Without their action, no healing will occur.

Furthermore, Mather incorporates patient narratives into his text, thereby validating patient participation in healing and medical practice. He writes of one woman, whom he calls “Thankful Fish,” who was “Enfeebled” by a series of headaches and hysterical fits in her early teens, reaching the point where she could “neither Step nor Stand, for Ten Years together, but was confined unto a low Chair, in which on a Smooth floor She could sometimes move a little from one place to another” (52). Mather emphasizes the woman’s perceived powerlessness—she was essentially immobilized for ten years and needed “two or three Persons” to help carry her to church (52)—but also her role in her own healing. Through prayer, she regained agency and ultimately recovered. He records her experience, saying: “She had a Strong Impression on her Mind, that if she were carried unto Rhode-Island, she should there find a Cure: But the Physicians there honestly told her There was nothing to be done for her” (52). Despite her disappointment, she did not despair and instead turned to prayer and to a malt-bath cure. Even though her friends discouraged her from taking it, she persisted and took the malt bath. After soaking for twenty minutes she apparently “Died away,” but then quickly began to recover. Miraculously, after a week she was able to walk to church by herself (52). In this case, the ill woman was integral to her own care; after all, she took the initiative to ask for prayer, to relocate to Rhode Island, and to take the malt bath. As Nicholas Junkerman argues, when “confronted with her friends’ effort to define the limits of her agency, she shows herself to be highly mobile, persuasive, and effective in the social world” (2017, 74).18 This is just one example of how The Angel of Bethesda establishes a methodology that requires practitioners to listen to, and seriously consider, patient perspectives as part of a holistic approach focused on treating bodies and souls.

Perhaps to emphasize the efficacy of his medical epistemology, Mather records multiple cases of paralyzed individuals such as Thankful Fish who recover through a combination of prayer, repentance, and medical treatment. In another example, he notes the experience of a Mr. Robert Billig, who had lost the use of both of his legs and one of his arms as a result of gout and who could “hardly go a few Steps with Crutches” (53). Mather writes that Billig, “being one Day alone in his Parlour, he felt a Strong IMPULSE upon his Mind, which caused him with much Difficulty to creep up into his Chamber, and there with fervent Prayer pour out his Soul before the Lord. […] [W]hen he Rose from his Knees, not only was his Pain all gone, but he walked as well as ever in his Life” (53). Mather emphasizes that Billig was alone, highlighting his role in his own cure. No external parties are involved—only Billig and God. The cure did not come from the heroic actions of practitioners but through Billig’s decision to confront and repent for the sinful, gluttonous behaviors that caused his gout. Treatment by doctors alone was not enough; it was not until Billig became actively involved that he was able to fully recover.

Though both Thankful Fish and Billig’s accounts are mediated through Mather, they are nevertheless valid narratives that intentionally authorize the patients’ role in achieving both physical and spiritual cures. After all, it is not intercessory prayer by ministers that cures them or even taking remedies recommended by physicians; on the contrary, it is their own prayer and acknowledgement of their sinfulness, in combination with medicinal treatment, that serves as the catalyst for their restitution. These brief accounts are, moreover, typical of works by marginalized populations in the period in that they are often fragmentary, brief, or related second-hand by prominent figures; further, they “range in length,” and are “often embedded in other texts such as travel narratives, diaries, and journals or appear in records kept by legal, medical, or religious institutions” (Aljoe 2012, 13). In this case, the marginalized group includes those largely isolated in their homes due to illness. Though it could be argued that these embedded medical narratives do not indicate individual agency because they are mediated and therefore serve Mather’s larger editorial aims, Nicole N. Aljoe reminds us that “assumptions of all-encompassing editorial power are unsupportable,” arguing instead that “dictated narratives provide evidence of the impossibility of completely controlling the words and language of another” (2012, 15, 16). Though the brief narratives of Billig and Thankful Fish are interpolated into Mather’s larger account, included because they support his arguments about the somatic ramifications of sin and repentance, they simultaneously record instances of patient agency, as the two afflicted individuals effectively act to restore their own health. Therefore, their stories reveal how, for Puritans, patients must be actively involved in their own treatment in order for a cure to fully work. Similarly, Mather’s inclusion of the patient as a reader aligns with the Puritan’s holistic view of medicine; as a “Healer of whole persons,” Mather sought to diagnose and treat the sins that most likely caused the illness in the first place (Kennedy 2015, 39).19 Thus, Mather’s text reveals how the Puritan conception of illness as caused by sin validated patient agency in medical treatment and required practitioners to listen to those afflicted with illness.

Righteous restitution: the recovered body and soul

In addition to counseling patients on how to interpret illness and validating the patient’s role in the process, Mather, throughout The Angel of Bethesda, prioritizes the individual’s role in public health by arguing that immunity from disease should be viewed as a metaphor for how the patient will live post-illness—making the sin, and therefore the disease, unrepeatable. Therefore, Mather provides a pattern for convalescent patients to replicate in order to reach full physical and spiritual restitution: recognize that God has afflicted you with a condition for a reason, repent and address the sinful behavior, and, once healed, praise God, engage in his work, and share your experience with others. Considering his status as a renowned minister, scion of two of the most famous ministerial families in New England, graduate of Harvard, author of numerous texts, and member of the Royal Society, Mather is in many ways creating what Frank terms an Institutional Restitution Narrative.20 Much as modern hospitals provide brochures that model “the stories patients ought to tell about their own illnesses,” Mather creates a template for identifying the patient’s role in causing and curing sins/illnesses and for appropriately recounting that experience to preemptively heal and morally inoculate their neighbors (Frank 2013, 79). In his chapter on small pox, for instance, Mather asserts that, “It has hardly ever been seen, that any after having Suffered it Once, comes to Suffer it a Second time” (97). He goes on to suggest that this inoculation is a result of genuine reformation, as he hopes “that the Grosser Sins, which thou hast once Repented of, thou wilt never again fall into them” (97). In other words, the patient’s narrative of spiritual and physical restitution is vital to preventing a recurrence of smallpox and emphasizes the value of recovered patients. Those who are inoculated—whether spiritually or physically—against sin and disease are inherently valuable to the long-term health and prosperity of the entire community. For Puritans, restitution is about a holistic view of the patient and is focused not only on the individuals’ well-being but on that of the public as well.21 Patients, rather than being passive bodies acted on by doctors, are not only active listeners—and readers—pursuing information about treatment options available across the Atlantic world, they are also active speakers, communicating about symptoms, treatments, and desired outcomes.

To this end, Mather provides his own restitution narrative as a model for patients; the narrative is embedded within his chapter on stammering, a condition he experienced through much of his youth and which he feared would prevent him from following his forefathers into the ministry. In fact, he only read medicine at Harvard because he wanted an alternate career path in case he was not able to become a minister. Up to this point, scholars generally interpret Mather’s stammer as a physical manifestation of the “pressure of paternity” or as “a kind of personal Genesis-myth” (Breitwieser 1984, 41, 43).22 Moving away from psychologizing Mather’s childhood, however, it is useful to employ the methods of narrative medicine to examine the stories he himself creates around his stammer. For his own part, in his youth Mather tended to interpret his condition through either the lens of medical providentialism or biblical typology—a common Puritan practice of identifying how an individual’s experiences align with those of major biblical figures or types. In his diaries, he articulates a typological reading of his condition, likening his experience to that of Moses. He records his pleas to God: “Thou dost send mee forth, as thou didst Moses, in Service for thy Name among thy people; […] But how desolate shall I bee, if I am left without Speech for thy Work! I trust in thee; and therefore it shall not bee. Thou saist (sic), Thou wilt never forsake them that seek thee” (Mather 1957, 2-3). By invoking Moses as a type, Mather interprets his condition as a test of faith rather than as a punishment for a particular sin, perhaps because he did not fully develop his one-to-one, sin-to-somatic symptom correlations until later. Though he does not identify a particular sin, he nevertheless believes that God caused his stammer for a reason. Because he interprets his stammer as a test and himself as a Moses type, the diaries leave open the possibility that he could pass the test and become a minister.

Later in his life, however, Mather reflects on his experience and composes a brief restitution narrative revealing how he interpreted the condition long after its apparent resolution. In The Angel, it is hard to read Mather’s commentary on stammering with its powerful language and specific examples of the frustration and humiliation people with stammers feel without considering the extent to which he may be venting his own experience throughout the chapter, not just in his clearly demarcated restitution narrative embedded within that section. In addition to describing the bitterness caused by the condition, he writes that those who stammer may feel unhappiness, humiliation, misery, and that they may be the “Object[s] of Inhumane Derision” (226). It is possible to speculate that Mather is, as Kenneth Silverman argues, “speaking impersonally but evidently from distressing personal experience,” as he draws on past trauma to inform his analysis of the plight of the stammerer (Silverman 1984, 16). One can easily imagine the teenage Mather at Harvard, for example, when he writes, “You Sitt alone and keep Silence, because you have born what you have upon you: yea, you putt your Mouth in the Dust and speak little more than the Dead” (227). Mather’s pain is conveyed through the prose here, forcing the reader to empathize with his plight, with feeling so outcast by society, and so frustrated with their own inability to speak that they choose a death-like silence instead. Yet the biblical passage Mather cites also offers the promise of redemption. He quotes Lamentations 3:29; the second part of that verse and the subsequent verses reinforce the idea of hope for the penitent, saying, “He putteth his mouth in the dust; if so be there may be hope…For the Lord will not cast off for ever” (Lamentations 3:29-31). Prayer, repentance, and scripture are the tools Mather offers as strategies to overcome the despair caused by stammering in order to achieve spiritual, physical, and social recovery.

Restitution, for Mather, involves not only his own physical restoration or ability to overcome his condition but also requires that he engage in God’s work in the community through his position as a preacher. Mather’s specific restitution story appears toward the end of the chapter; at this point, he provides enough autobiographical information to indicate clearly that he is speaking of his own experience. Notably, Mather does not write his account in the first person but in the third, perhaps because he does not want to diminish the authority of the example by admitting it is his own experience or because the third person allows him the distance to explore the painful memories of his youth. Mather begins by writing, “I know one, who had been very much a Stammerer; and no words can tell, how much his Infirmity did Encumber and Embitter the first years of his Pilgrimage” (230). He relates how a trusted friend came to him while he was at school and encouraged him to sing the Psalms as a tool for practicing what he calls “deliberation.” By emulating songs in his speech and using the rhythm to carry his words, Mather claims that he used scripture and music to overcome his condition and to achieve success as a minister. Unlike the earlier examples of Thankful Fish and Billig, Mather follows the advice of an advisor to undergo a form of speech therapy using the Psalms, but it is his own deliberation, and perhaps his sheer force of will, that enables him to apparently overcome his stammer. “The young Man soon became a Preacher in Great Congregations,” he declares, “which was a Thing as much despaired of, as anything in the World. He continued more than Forty years in the Service of the Churches; […] and he was Employed in making Speeches on the most public Occasions” (231).23 More significantly, as God and faith were instrumental to the solution, Mather demonstrates that the truly healed person must not only continue to engage with God by being thankful but must also live a faithful life and serve the community, again underscoring the value of recovered individuals in Puritan society. His own life not only models this behavior, as he became an influential minister, but by writing The Angel of Bethesda, Mather further acts to serve the spiritual and physical health of the community. The book, in other words, is a model for every stage of the restitution process in Mather’s theological-medical construction.

Mather’s short restitution narrative sets up his larger chapter, “Restitutus or, A Perfect Recovery, in the wise and good Conduct of one Recovered from a Malady,” which deals with restitution for individuals recovering from any condition, not just stammering. Here, he explicitly declares that a physical recovery that does not correct the underlying sinful behavior “will not be a Perfect Recovery” (311). He then clarifies this position, writing: “Be sure, If People Recovered from Diseases, do persist in a State and Course of Sin, and if they do Refuse also to Reform what Special Sin they may Discern God in their Affliction managing a Controversy with them for; they may justly fear, that a Worse Thing will come unto them” (314). Restitution, in other words, is about more than treating physical symptoms; recovery also requires convalescents to get their souls right with God which, as we have seen, brings the patient—body and soul—to the fore.

In addition to extolling readers to reform their sinful behavior as part of the recovery process, Mather outlines the appropriate behaviors a person should display to achieve their full cure. First, they must, naturally, praise God for his help in alleviating the affliction. Mather declares, “You will consider the Glorious God your SAVIOUR, as the Author of all the Good that has been done for you, and give Him the Glory of it” (312). He even goes so far as to suggest specific verses and Psalms that are most appropriate for glorifying God after an illness; he is particularly fond of Psalm 30:1-2 and 30:12. Not only must persons correct their sins and praise God, but they must also learn from their experience of illness. “Certainly,” Mather writes, “You ought now to be Wiser than you have been, and Receive Instruction when you have Endured Correction” (313). Considering disease as a tool employed by God to instruct His chosen people allows Mather to frame disease as a teachable moment; the truly recovered “pupils” must not only respond to the lesson in the short term, they must amend their future behavior to prevent a recurrence or escalation of the condition. Avoiding or repenting sins, then, can almost be read as a form of preventative medicine. He warns, “Be sure, if People Recovered from Diseases, do persist in a State and Course of Sin, […] they may justly fear, that a Worse Thing will come unto them” (314). The warning here is particularly important because God does not always afflict the sinner with illness under the tenets of medical providentialism—those around them might be afflicted instead. A properly recovered person helps ensure the health of the community as their sins can no longer “infect” their neighbors.

Finally, one of the most empowering aspects of Mather’s construction of restitution is that patients must share their story to serve the public good like Mather himself did. While not everyone is required to become a minister, he encourages everyone to serve God once they recover. Many Puritans incorporate their restitution narratives into their conversion narratives, ensuring that stories of their affliction circulated publicly.24 In a sense, sharing their narrative of sin, illness, repentance, and recovery functions as a form of social inoculation, as listeners who heed the moral of the story and reform prior to illness can, theoretically, circumvent future sicknesses. Thus, individuals need to be engaged not only while they are sick and convalescing but also, according to Puritan medical-theological praxis, upon their recovery. Patients have a moral responsibility to themselves and their communities to stay active in preventing disease even after they have recuperated. Sharing narratives of restitution validates patients, transforming them from marginalized individuals into exemplars of how to interpret and respond to disease. Restitution stories, when included in letters, sermons, poems, and other public forms, situate recovery in a social context, encouraging people to share their experience for the spiritual benefit of others.

Conclusion: the role of patients in medical care

Even though Mather was unable to publish The Angel of Bethesda in his lifetime, it is a representative early work of narrative medicine that both reveals how medical providentialism authorized agency during illness and that underscores restitution narratives as an eighteenth-century form.25 Through this text, Mather suggests an alternate understanding of sickness, healing, and the role of patients than that promulgated by his European counterparts and increasingly secular Enlightenment professional medicine more generally. The text, therefore, represents Puritan epistemologies at the intersection of health, medicine, and theology that emphasize the role of patients in facilitating healing by reforming sinful behaviors that they believed caused disease. Puritan medical theory, as articulated by Mather, also encourages doctors to resist abstracting patients instead reminding them to communicate and to express patience and empathy throughout the healing process. Each person brings unique experiences and feelings to medical encounters, and, in The Angel of Bethesda, Mather shows one method for keeping the patient at the center, rather than the margins, of the narrative and of their own medical experiences.

By focusing on how Puritan medical epistemologies provide patients with an understanding of illness and restitution as social and how they focus on the edification of the community, we can better understand the genre of restitution narratives in the eighteenth century. Medical providentialism provided a discourse that enabled people to articulate their medical experiences prior to the Enlightenment, or indeed, to postmodernism. Narrative medical strategies, though different from those employed in the postmodern period, have existed for centuries. Moreover, early American narratives of illness, even when mediated, reveal how patients constructed theological meanings for sickness and how that knowledge enabled them to construct authority during medical uncertainty. This is not to say that patients know more than or should not also listen to medical professionals; rather, practitioners and patients should work together to establish an effective treatment plan. Resituating Mather’s medical treatise as an early, though certainly not the earliest, example of narrative-based medical praxis, we see how Puritan constructions of illness establish significance and meaning. In The Angel of Bethesda, Mather articulates the important role patients should play in medicine and validates patient agency by considering them as whole human beings whose thoughts, actions, and lifestyles influence their health. Puritans understood bodily afflictions as important discursive signs and therefore valued recovered persons because they indicated hope for the possible recovery of the entire physical and spiritual community. Members of the church, those who seemed to be favored by God, served as exemplars modeling how to interpret affliction-grace cycles as part of the larger Puritan project of understanding God’s actions in the world. Healthy and recovered individuals, therefore, were inherently valuable to the moral edification of the community, and were markers of God’s favor.

Furthermore, understanding how patients and practitioners theorized agency in the eighteenth century reveals how theological and scientific epistemologies can be mutually informative, thus illuminating constructive possibilities for enhanced patient care. If, as scholars of narrative medicine have argued, patient agency can be expressed through narrative, then looking back at earlier narrative strategies can open up possibilities for understanding modern medical discourses. Recognizing how restitution has been historically defined creates the space for alternate understandings of restitution. In other words, even though it may be impossible to restore patients’ bodies to their prior healthy condition for a variety of reasons, allowing individuals to define restitution for themselves—which might involve restoring patients’ spiritual or emotional well-being, or providing accommodations to ensure the patient has a comparable quality of life—can lead to positive medical experiences even if the patient is not “cured.” Thus, these narratives offer a method to move away from viewing the sole purpose of medicine as the complete cure of all physical ailments, a standard that problematically frames chronic conditions and disabilities as medical “failures.” The Angel of Bethesda, though not a model for contemporary medical treatment, aligns with narrative medical practices by validating patient narratives, and by encouraging practitioners to communicate with patients with an ear for empathy, compassion, and holistic healing.